I have a Public Service announcement! It's about PSA. Yes, that's right, prostate-specific antigen (PSA). The Prostate Cancer Foundation says 1 out of 8 men will be diagnosed with prostate cancer. Many people don't know that September is National Prostate Cancer Awareness Month. November is also Men's Health Awareness Month which brings awareness to men's health concerns, including prostate cancer. Many men are unaware of symptoms or are asymptomatic while experiencing early stages of prostate cancer.
THE PROSTATE & ITS SPECIFIC ANTIGEN
Inside a man's jewels lies a small, rubbery ball-like structure called the prostate gland. It sits under the bladder, across from the rectum, and surrounds the urethra. This gland is responsible for making seminal fluid for a man to release his life into the world. PSA is a protein produced in the prostate gland that helps in the production of seminal fluid. This seminal fluid combines with sperm cells to produce wonderfully well-balanced and lubricated semen that can swim freely into the promised land. In other words, without the prostate gland, a man's reproductive abilities are entirely lost.
High levels of PSA are found in the prostate gland and in man's semen. Small amounts will escape and be found in the bloodstream which is normal.
PSA LEVELS
The PSA screening is one tool used to assess prostate health. During the screening, a standard blood draw is conducted to measure PSA levels in blood (serum). The unit used to measure serum PSA count is ng/ml (nanograms per milliliter). * Remember: the prostate gland & semen contain the majority of a man's PSA, not his bloodstream*
This chart explains PSA screen results and their interpretation. In general, "normal" serum PSA levels go up to 4 ng/mL. The risk of prostate cancer increases the higher the PSA is. However, an elevated PSA does not automatically mean cancer. It is just one risk factor. Another test called a prostate biopsy would need to be conducted to confirm if cancer was present.
Even with this, these numbers are not a one-size-fits-all. Ranges for prostate-specific antigen can vary between men depending on their age and ethnic background. Here is a chart from the Sperling Prostate Center in New York that explains how specific factors yield different healthy prostate health ranges in men's health.
As a man ages, his serum PSA range increases. These ranges are important for many reasons, but again should not be used as the sole screen for prostate cancer. PSA levels can increase in many ways outside of prostate cancer.
NON-CANCEROUS REASONS FOR ELEVATED PSA:
Age:
As a man ages, his prostate gland naturally grows. This may elevate serum PSA levels. According to the reference range chart used above, a man in his 70s has a higher tolerable PSA than a man in his 40s. This higher PSA does not automatically mean an increased chance of prostate cancer. It comes back down to the fact that our prostate gland grows as we age. And because the prostate gland size increases, more PSA is produced as a result.
UTIs or Urinary incontinence:
Urinary tract infections or incontinence can cause an increase in serum PSA levels. And again, it comes down to an enlarged prostate. This puts pressure on a man's bladder which can lead to his inability to control urine flow (incontinence). Bacteria can also grow in the urinary tract due to this pressure. Though this does not sound pleasurable, it still is not the same as prostate cancer and is considered a non-cancerous reason for elevated PSA levels.
Biking/Cycling Many myths surround biking/cycling & increased prostate cancer risk. According to The Urology Group, cycling may cause temporary spikes in PSA, but they agree that the benefits of cycling for long-term health outweigh the risks. Other sources state that prolonged cycling can lead to prostate enlargement and inflammation (prostatitis) due to pressure applied on the prostate gland. It is important to take precautions while doing activities like these. Men can practice safety by ensuring that clothes fit correctly and are not too tight. Taking the time to get fitted for a seat that doesn't place too much pressure on the prostate gland can also help.
Ejaculation
Yep, you heard it right. However, the research on this is mixed. Some studies say that PSA levels in men in their 20s and 30s are not affected after ejaculation but are for men in their 40s and up. Other studies say that all men's PSA levels increase after ejaculation. The increase happens within hours to 2 days after ejaculation. Because of this, men should wait 48 hours after having sex before getting a PSA screen.
Enlarged Prostate Yes, you read that correctly. The prostate gland gets enlarged. However, an enlarged prostate is not the same as prostate cancer. Benign prostatic hyperplasia is the diagnostic term for an enlarged prostate. Prostate cancer occurs when a tumor grows in the prostate gland. BIG difference. One can have an enlarged prostate without prostate cancer. One may have prostate cancer without an enlarged prostate (though this is more unlikely).
DIFFERENCE BETWEEN:
BENIGN PROSTATIC HYPERPLASIA
Here is a photo of a normal prostate gland & an enlarged one. Notice what it does to the
urethra and how the inflammation can lead to difficulty with urine flow. In this case, PSA levels are elevated, but no cancer (tumor) is present.
PROSTATE CANCER
In this photo (4 of 5 stages represented), a cancerous tumor is present in the prostate and begins to progress. Notice how in this photo, consistent urine flow is maintained during all stages of cancer growth (which is case-specific). We then begin to see the tumor pressing against the urethra, which leads to difficulty urinating. A biopsy would be needed to diagnose the cancer & determine its stage.
WHO SHOULD GET A PSA SCREEN?
According to many sources including the National Comprehensive Cancer Network (NCCN), prostate and Advanced Urology Institute, PSA screenings are not 100% necessary for all men. It all depends on your risk. Unfortunately:
Men who are African & Caribbean
Men with first or second-degree relatives who had prostate cancer
Men with a first-degree relative who developed prostate cancer at a young age (<50 years)
are all at increased risk of developing prostate cancer.
Historically, black men have higher incidence and mortality from prostate cancer, and I'm sure there are many reasons for that (including health access and other socioeconomic factors). Men who are at higher risk benefit from PSA screenings starting as early as 40 years old. They should work with their healthcare team to employ shared decision-making & active surveillance.
Shared decision-making is a form of patient-centered care where clinicians and patients work together to select the best treatment options depending on safety, risks, treatment methods, and other factors.
Active surveillance entails regular prostate screenings to determine what further testing & treatment options are necessary to maintain prostate health.
AND TO WRAP IT UP.
No pun intended..... PSA SCREENINGS ALONE ARE NOT SUFFICIENT ENOUGH to determine prostate cancer diagnosis or stage. Please keep this in mind. Don't stress. Don't worry. Shared decision-making should be applied between you, your Primary Care Physician, and Urologist to determine the best screening & treatment plans for you. The bottom line is that PSA is not the most important thing, but is a great non-invasive first step to understanding a man's prostate health. Now that you have received this PSA about PSA, the next step is to get it checked. I'll talk about lifestyle factors and the role of food and nutrition in prostate health at another time. Drop a comment and let me know what you think about this article
Share what you would love to hear about next. Until then, Gregory Lafortune, MS, RDN, LD
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